照護一位腹膜透析患者面對血液透析治療的護理經驗

The Nursing Experience of Taking Care of a Patient Shifting from Peritoneal Dialysis to Hemodialysis

本文探討一位腹膜透析患者，因腹膜炎導致須轉血液透析的護理經驗。筆者於97年7月16日至97年9月13日，藉由觀察、會談、身體評估、檢驗數據、病歷查閱及諮詢腹膜透析小組之方式，以Gordon十一項健康型態評估，發現個案有：健康維護能力改變、潛在危險性感染、睡眠形態紊亂。筆者於照護期間，先針對個別性、獨特性提供有計劃的衛生教育，加以澄清錯誤的觀念及治療差異，並介紹腎友提供經驗分享，確實改善生理與心理的不適應；提供傷口護理及預防措施，使腹部傷口、廔管、廔管皆無感染情形；鼓勵個案適時說出心中感受，提供促進睡眠方法，有效提升睡眠品質。同時促使個案能以健康積極的態度繼續維持以往生活型態，面對及接受須與透析共度一生的事實。

It is a long process for a patient to accept kidney failure and life-long dialysis treatment. There's need of assistance in getting a patient to move from denial to acceptance. This article describes the nursing experience for such a patient and how the help was given. This patient stopped CAPD due to peritonitis. The patient’s condition was evaluated via Gordon scale from observation, interview, physical evaluation, laboratory examination and experts who were consulted. We discovered the following problems related to the case: less ability in maintaining self health, the potential for infection and sleep disorder. A detailed hygiene education program was put into effect, which included a health-centered way of thinking derived from our experts and other dialysis patients' conversation to reconstruct patient's mental quality. Proper wound treatment was employed to avoid infection during puncturing of the fistula, encouraging the patient to express his feelings and providing methods to improve sleep. These measures helped the patient to live harmoniously with dialysis treatment.